Skip to main content

Advertisement

SpringerLink
Log in

Consolidation regimens in primary central nervous system lymphoma: a single-center retrospective cohort evaluating survival outcomes and cost–benefit analysis

  • Research
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Optimal treatment for primary central nervous system lymphoma (PCNSL) comprises polychemotherapy induction with high-dose methotrexate followed by consolidation therapy, but there is no standard treatment regimen because of a lack of comparative trials examining efficacy or relative value. We performed a retrospective outcome and relative cost analysis on consolidation regimens to gain perspective on how cost and benefit can be weighed in medical decisions for patients with PCNSL.

Methods

Patients with newly diagnosed PCNSL who completed consolidation at our institution from July 1, 2012, to March 1, 2019, were included. Patients completed etoposide/cytarabine (EA), high-dose cytarabine (HIDAC), or high-dose chemotherapy with autologous stem-cell rescue (HDC-ASCR) as consolidation regimen. Data were collected from the electronic medical record and our institution’s Value Driven Outcomes tool. Survival was analyzed as date of diagnosis to last known date of survival.

Results

Of the 22 patients included in the study, 12 completed the EA regimen, 4 completed HDC-ASCR, and 6 completed HIDAC. Facility and pharmacy costs contributed most to the cost of each treatment. HDC-ASCR treatment was 50× the cost of the cheapest treatment, HIDAC. Outcomes were numerically superior with HDC-ASCR and HIDAC compared with EA (2-year progression-free survival 100% vs. 100% vs. 63.6%, respectively, p = 0.1915).

Conclusion

This small retrospective cost–benefit analysis provides evidence that HDC-ASCR may be a superior treatment for PCNSL but at a higher cost than other consolidation regimens. HIDAC may increase value for patients, including elderly patients, who are not appropriate candidates for HDC-ASCR when compared with EA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3 

Similar content being viewed by others

Data availability

The datasets generated during and or analyzed during the current study are not available.

References

  1. Mendez JS, Ostrom QT, Gittleman H et al (2018) The elderly left behind-changes in survival trends of primary central nervous system Lymphoma over the past 4 decades. Neuro Oncol 20:687–694. https://doi.org/10.1093/neuonc/nox187

    Article  PubMed  Google Scholar 

  2. Grommes C, DeAngelis LM (2017) Primary CNS Lymphoma. J Clin Oncol 35:2410–2418. https://doi.org/10.1200/JCO.2017.72.7602

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rubenstein JL, Gupta NK, Mannis GN et al (2013) How I treat CNS Lymphomas. Blood 122:2318–2330. https://doi.org/10.1182/blood-2013-06-453084

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Templates N (2014) Primary CNS Lymphoma rituximab primary CNS Lymphoma. J Clin Oncol 35:2013–2014

    Google Scholar 

  5. Abrey LE, Yahalom J, DeAngelis LM (2000) Treatment for primary CNS Lymphoma: the next step. J Clin Oncol 18:3144–3150. https://doi.org/10.1200/JCO.2000.18.17.3144

    Article  CAS  PubMed  Google Scholar 

  6. Omuro AMP, Ben-Porat LS, Panageas KS et al (2005) Delayed neurotoxicity in primary central nervous system Lymphoma. Arch Neurol. https://doi.org/10.1001/archneur.62.10.1595

    Article  PubMed  Google Scholar 

  7. Omuro A, Correa DD, DeAngelis LM et al (2015) R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS Lymphoma. Blood 125:1403–1410. https://doi.org/10.1182/blood-2014-10-604561

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Rubenstein JL, Hsi ED, Johnson JL et al (2013) Intensive chemotherapy and immunotherapy in patients with newly diagnosed primary CNS Lymphoma: CALGB 50202 (Alliance 50202). J Clin Oncol 31:3061–3068. https://doi.org/10.1200/JCO.2012.46.9957

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Batchelor T, Giri S, Ruppert AS et al (2021) Myeloablative versus non-myeloablative consolidative chemotherapy for newly diagnosed primary central nervous system Lymphoma: results of CALGB 51101 (Alliance). J Clin Oncol 39:7506–7506. https://doi.org/10.1200/JCO.2021.39.15_suppl.7506

    Article  Google Scholar 

  10. Schorb E, Finke J, Ferreri AJM et al (2016) High-dose chemotherapy and autologous stem cell transplant compared with conventional chemotherapy for consolidation in newly diagnosed primary CNS Lymphoma—a randomized phase III trial (MATRix). BMC Cancer 16:282. https://doi.org/10.1186/s12885-016-2311-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ferreri AJM, Cwynarski K, Pulczynski E et al (2017) Whole-brain radiotherapy or autologous stem-cell transplantation as consolidation strategies after high-dose methotrexate-based chemoimmunotherapy in patients with primary CNS lymphoma: results of the second randomisation of the International Extranodal L. Lancet Haematol 4:e510–e523. https://doi.org/10.1016/S2352-3026(17)30174-6

    Article  PubMed  Google Scholar 

  12. Houillier C, Taillandier L, Dureau S et al (2019) Radiotherapy or autologous stem-cell transplantation for primary CNS Lymphoma in patients 60 years of age and younger: results of the intergroup ANOCEF-GOELAMS randomized phase II PRECIS study. J Clin Oncol 37:823–833. https://doi.org/10.1200/JCO.18.00306

    Article  CAS  PubMed  Google Scholar 

  13. Prica A, Chan K, Cheung M (2014) Combined modality therapy versus chemotherapy alone as an induction regimen for primary central nervous system Lymphoma: a cost-effectiveness analysis. Neuro Oncol 16:1384–1391. https://doi.org/10.1093/neuonc/nou057

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Beca JM, Raza K, Mow E et al (2020) Cost-effectiveness analysis of rituximab with methotrexate, cytarabine and thiotepa for the treatment of patients with primary central nervous system Lymphoma. Leuk Lymphoma 61:1097–1107. https://doi.org/10.1080/10428194.2020.1711902

    Article  CAS  PubMed  Google Scholar 

  15. Kawamoto K, Martin CJ, Williams K et al (2015) Value driven outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes. J Am Med Inform Assoc 22:223–235. https://doi.org/10.1136/amiajnl-2013-002511

    Article  PubMed  Google Scholar 

  16. Abrey LE, Ben-Porat L, Panageas KS et al (2006) Primary central nervous system Lymphoma: the memorial sloan-kettering cancer center prognostic model. J Clin Oncol 24:5711–5715. https://doi.org/10.1200/JCO.2006.08.2941

    Article  PubMed  Google Scholar 

  17. Schnipper LE, Davidson NE, Wollins DS et al (2016) Updating the american society of clinical oncology value framework: revisions and reflections in response to comments received. J Clin Oncol 34:2925–2934. https://doi.org/10.1200/JCO.2016.68.2518

    Article  PubMed  Google Scholar 

  18. Lee VS, Kawamoto K, Hess R et al (2016) Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. JAMA 316:1061. https://doi.org/10.1001/jama.2016.12226

    Article  PubMed  Google Scholar 

  19. Jafari L, Hussain J, Krishnadasan R et al (2019) Implementation of outpatient high-dose cytarabine (HiDAC) for AML: evaluation of the impact of transitioned outpatient chemotherapy in an oncology care model setting. Blood 134:2153–2153. https://doi.org/10.1182/blood-2019-132121

    Article  Google Scholar 

  20. Schorb E, Fox CP, Fritsch K et al (2017) High-dose thiotepa-based chemotherapy with autologous stem cell support in elderly patients with primary central nervous system lymphoma: a European retrospective study. Bone Marrow Transplant 52:1113–1119. https://doi.org/10.1038/bmt.2017.23

    Article  CAS  PubMed  Google Scholar 

  21. Scordo M, Bhatt V, Hsu M et al (2017) A comprehensive assessment of toxicities in patients with central nervous system Lymphoma undergoing autologous stem cell transplantation using thiotepa, busulfan, and cyclophosphamide conditioning. Biol Blood Marrow Transpl 23:38–43. https://doi.org/10.1016/j.bbmt.2016.09.024

    Article  CAS  Google Scholar 

  22. Creditor MC (1993) Hazards of hospitalization of the elderly. Ann Intern Med 118:219. https://doi.org/10.7326/0003-4819-118-3-199302010-00011

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the Huntsman Cancer Institute Neurologic Disease Center, which is partially supported by the Huntsman Cancer Foundation. Use of the Research Informatics Shared Resource was provided by Huntsman Cancer Institute and supported by the Huntsman Cancer Institute’s Cancer Center Support Grant No. P30CA42014 from the National Cancer Institute of the National Institutes of Health. Resources of the Center for Neurologic Cancers were supported by Huntsman Cancer Institute and the Huntsman Cancer Foundation.

Author information

Author notes

  1. Adam L. Cohen

    Present address: Inova Schar Cancer Institute, Fairfax, VA, USA

Authors and Affiliations

  1. School of Medicine, University of Utah, Salt Lake City, UT, USA

    Savannah Gelhard

  2. Total Cancer Care Department, Huntsman Cancer Institute, Salt Lake City, UT, USA

    Amiee Maxwell

  3. Winona State University, Winona, MN, USA

    Amiee Maxwell

  4. Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Howard Colman & Joe S. Mendez

  5. Division of Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Adam L. Cohen

Authors
  1. Savannah Gelhard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amiee Maxwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Howard Colman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam L. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joe S. Mendez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by SG and AM. Data analysis and interpretation was completed by SG, AM, JM, and AC. The first draft of the paper was written by SG and JM, and all authors commented on previous versions of the paper. All authors read and approved the final paper.

Corresponding author

Correspondence to Joe S. Mendez.

Ethics declarations

Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

This is a retrospective observational study. The University of Utah IRB approved this study with a waiver of informed consent as protocol #66337.

Consent to participate

Exemption to informed consent was obtained through IRB approval for this retrospective study.

Consent to publish

Exemption to informed consent was obtained through IRB approval for this retrospective study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gelhard, S., Maxwell, A., Colman, H. et al. Consolidation regimens in primary central nervous system lymphoma: a single-center retrospective cohort evaluating survival outcomes and cost–benefit analysis. J Neurooncol 159, 293–300 (2022). https://doi.org/10.1007/s11060-022-04064-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-022-04064-x

Keywords

Search

Navigation